51
|
The effectiveness of a therapist-oriented home rehabilitation program for a patient with acromegaly: A case study. J Bodyw Mov Ther 2019; 23:634-642. [PMID: 31563382 DOI: 10.1016/j.jbmt.2019.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 01/24/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Acromegaly causes numerous functional limitations that negatively impact patients' performance of activities of daily living (ADLs) and contribute to the deterioration of health-related quality of life (HRQoL). Thus, the purpose of the present case study was to evaluate the effect of therapist-oriented home rehabilitation (TOHR) for a patient with acromegaly. CASE DESCRIPTION We report the case of a 53-year-old man who was diagnosed with primary acromegaly 17 years ago. He complained of difficulties performing tasks that involved his hands, pain in the lower limbs, and fatigue when he climbed a few flights of stairs. Although he performed ADLs independently, he reported some difficulties or discomfort when performing them. INTERVENTION AND OUTCOME The patient underwent a booklet-guided physical exercise program that lasted two months (three times per week, 60 minutes per session). The activities included overall stretching, muscle strengthening, and endurance exercises, along with aerobic conditioning through functional circuit training. After two months of exercise, he reported improved HRQoL as assessed with the Acromegaly Quality of Life Questionnaire, with increases in quadriceps muscle strength and 6-min walking distance. However, none of these benefits remained when the patient was assessed after a 1-month washout period. CONCLUSION This study showed that patients with acromegaly may benefit markedly from TOHR, which could provide a novel therapeutic approach as an adjunct to hormone control therapy.
Collapse
|
52
|
Lobatto DJ, Steffens ANV, Zamanipoor Najafabadi AH, Andela CD, Pereira AM, van den Hout WB, Peul WC, Vliet Vlieland TPM, Biermasz NR, van Furth WR. Work disability and its determinants in patients with pituitary tumor-related disease. Pituitary 2018; 21:593-604. [PMID: 30288666 PMCID: PMC6244796 DOI: 10.1007/s11102-018-0913-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Pituitary tumors may have a considerable impact on patients' functional status, including paid employment, yet research in this area is sparse. OBJECTIVE To describe work disability and its determinants in patients treated for a pituitary tumor. METHODS Cross-sectional study including patients treated for a pituitary tumor in the working age (18-65 years), who completed five validated questionnaires assessing work disability [Short Form-Health and Labour Questionnaire, Work Role Functioning Questionnaire 2.0 (WRFQ)], health-related quality of life (HRQoL) and utility (Short Form-36, EuroQoL) and disease burden (Leiden Bother and Needs Questionnaire-Pituitary). Additional data were extracted from the medical records (age, gender, tumor type, treatment, date of diagnosis) and self-reports (marital status, education, endocrine status). Associations of disease-specific and sociodemographic characteristics, HRQoL, and disease burden with (not) having a paid job were examined through multivariate logistic regression. RESULTS We included 241 patients (61% female, median age 53 years, median time since diagnosis 11 years), of whom 68 (28%) were without a paid job. Patients who had acromegaly, Cushing's disease, (pan)hypopituitarism, radiotherapy, were single, less educated, lower HRQoL, and increased disease burden were more often without a paid job (p < 0.05). Among those with paid jobs, 41% reported health-related absenteeism in the previous year. The three work incapacitating problems reported by the largest proportion of patients were within the mental and social domain (WRFQ). CONCLUSION Work disability among patients treated for a pituitary tumor is substantial. As impact on social functioning is high, it is strongly advised to incorporate work disability during clinical guidance of patients.
Collapse
Affiliation(s)
- Daniel J Lobatto
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Anath N V Steffens
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | | | - Cornelie D Andela
- Division of Endocrinology and Center for Endocrine Tumors, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Division of Endocrinology and Center for Endocrine Tumors, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilbert B van den Hout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilco C Peul
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands
| | | | - Nienke R Biermasz
- Division of Endocrinology and Center for Endocrine Tumors, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Wouter R van Furth
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| |
Collapse
|
53
|
Abstract
BACKGROUND The delayed diagnosis, altered body image, and clinical complications associated with acromegaly impair quality of life. PURPOSE To assess the efficacy of the cognitive-behavioral therapy (CBT) technique "Think Healthy" to increase the quality of life of patients with acromegaly. METHODS This non-randomized clinical trial examined ten patients with acromegaly (nine women and one man; mean age, 55.5 ± 8.4 years) from a convenience sample who received CBT. The intervention included nine weekly group therapy sessions. The quality of life questionnaire the 36-Item Short Form Survey (SF-36) and the Beck Depression Inventory (BDI) were administered during the pre- and post-intervention phases. The Wilcoxon signed-rank test was performed to assess the occurrence of significant differences. RESULTS According to the SF-36, the general health domain significantly improved (d' = - 0.264; p = 0.031). The mental health domain improved considerably (d' = - 1.123; p = 0.012). Physical functioning showed a non-significant trend toward improvement (d' = - 0.802; p = 0.078), although four of the five patients who showed floor effects improved and remained at this level. Regarding emotional well-being, five patients showed floor effects and four improved, and the condition did not change among any of the four patients who showed ceiling effects. No significant changes were found with regard to the other domains. No significant differences in the BDI were found before or after the intervention. CONCLUSION The technique presented herein effectively improved the quality of life of patients with acromegaly with different levels of disease activity, type, and treatment time.
Collapse
Affiliation(s)
- Lia Silvia Kunzler
- SRTVS 701, Edifício Centro Empresarial Brasília, Bloco "C", sala 204, Asa Sul, Brasília, DF, CEP: 70.340-907, Brazil.
| | - Luciana Ansaneli Naves
- SRTVS 701, Edifício Centro Empresarial Brasília, Bloco "C", sala 204, Asa Sul, Brasília, DF, CEP: 70.340-907, Brazil
| | - Luiz Augusto Casulari
- SRTVS 701, Edifício Centro Empresarial Brasília, Bloco "C", sala 204, Asa Sul, Brasília, DF, CEP: 70.340-907, Brazil
| |
Collapse
|
54
|
Zimmermann A, Zwerenz R, Droste M, Schöfl C, Strasburger CJ, Plöckinger U, Ziagaki A, Honegger J, Dixius A, Millaku B, Toenges G, Beutel ME, Weber MM. Personality Traits and Physical Complaints in Patients With Acromegaly: A Cross Sectional Multi-Center Study With Analysis of Influencing Factors. Front Endocrinol (Lausanne) 2018; 9:391. [PMID: 30065700 PMCID: PMC6056634 DOI: 10.3389/fendo.2018.00391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/25/2018] [Indexed: 11/14/2022] Open
Abstract
Objective: Acromegalic patients display a distinct neuropsychological profile and suffer from chronic physical complaints. We aimed to investigate in more detail these aspects in acromegalic patients, dependent on influencing factors like disease activity, age, sex, chronic medication, surgery, pituitary radiation, pituitary insufficiency and comorbidities. Design: Cross sectional, multicentric. Methods: 129 patients (M/W 65/64, 58.3 ± 12.7 years, 53/76 with active/controlled disease). Acromegalic patients completed the following inventories: NEO-FFI, IIP-D, and the Giessen Complaints List (GBB-24), after written informed consent. Age, sex, IGF-1 concentrations, comorbidities, treatment modalities and pituitary insufficiency were documented. Results: Acromegalic patients or specific patient-subgroups were more agreeable, neurotic, exploitable/permissive, introverted/socially avoidant, non-assertive/insecure, nurturant and less open to experience, cold/denying, domineering, compared to normal values from the healthy population (controls). Multivariable analysis demonstrated that these overall results were due to the specific patient subgroups as patients on chronic medication, with arthrosis and pituitary insufficiency. Disease activity was only associated with the trait nurturant. Higher scores for introversion were associated with arthrosis. Lower domineering was independent of any disease- or treatment related variable or comorbidity. The GBB inventory showed overall higher scores in patients, with higher scores for exhaustion and general complaints being associated with pituitary insufficiency, coronary heart disease and history of malignancy in the multivariable analysis. Joint complaints were independent of any disease- or treatment- related variable. Conclusions: We define new aspects of a distinct neuropsychological profile in patients with acromegaly, which are largely independent of disease activity. Chronic physical complaints are more pronounced in patients than in controls, with exhaustion and general complaints showing no association with disease activity.
Collapse
Affiliation(s)
- Anca Zimmermann
- Department of Endocrinology and Metabolic Diseases, 1. Medical Clinic, University Medical Center, Mainz, Germany
- *Correspondence: Anca Zimmermann
| | - Rüdiger Zwerenz
- Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, University Medical Center, Mainz, Germany
| | - Michael Droste
- Endocrinology and Diabetology Praxis, Oldenburg, Germany
| | | | | | - Ursula Plöckinger
- Interdisciplinary Center of Metabolism: Endocrinology, Diabetes and Metabolism, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Athanasia Ziagaki
- Interdisciplinary Center of Metabolism: Endocrinology, Diabetes and Metabolism, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Honegger
- Neurosurgery Clinic, University of Tübingen, Tübingen, Germany
| | - Anne Dixius
- Department of Endocrinology and Metabolic Diseases, 1. Medical Clinic, University Medical Center, Mainz, Germany
| | - Bledar Millaku
- Department of Endocrinology and Metabolic Diseases, 1. Medical Clinic, University Medical Center, Mainz, Germany
| | - Gerrit Toenges
- Institute of Medical Biostatistics, Epidemiology and Informatics, University of Mainz, Mainz, Germany
| | - Manfred E. Beutel
- Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, University Medical Center, Mainz, Germany
| | - Matthias M. Weber
- Department of Endocrinology and Metabolic Diseases, 1. Medical Clinic, University Medical Center, Mainz, Germany
| |
Collapse
|